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Michael Petruzzelli

, National Council for Behavioral Health

CARA Authors Urge Comprehensive Approach to Compromise

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In a letter to their colleagues on the opioid conference committee, authors of the Comprehensive Addiction and Recovery Act (CARA) urged a holistic approach to negotiations. The letter – signed by Senators Sheldon Whitehouse (D-RI), Rob Portman (R-OH), Kelly Ayotte (R-NH), and Amy Klobuchar (D-MN) – demonstrates the broad, bipartisan support on Capitol Hill for achieving results to combat the nation’s opioid abuse crisis. Conference negotiations will resume next week when Congress is back in session.

Read the letter in full below:

Dear House and Senate Conferees:

Thank you for your commitment to strengthening federal efforts to address the scourge of substance abuse and the current opioid abuse epidemic.  Addiction and overdoses are claiming lives and destroying families in our home states of Rhode Island, Ohio, Minnesota, and New Hampshire, as well as across the United States.  In Rhode Island, 258 people lost their lives to overdoses in 2015—more than the number of those killed in homicides, suicides, and car accidents combined.  That same year, 438 people in New Hampshire were lost to a drug overdose, while the most recent figures for Ohio and Minnesota stand at 2,744 and 571, respectively.  We know the statistics tell a similar story in your states and districts.

As conference deliberations begin for the Comprehensive Addiction and Recovery Act (CARA), we hope that you will consider the process that informed the legislation as it was introduced in both the Senate and the House.  It is largely this process that lent the bill the support it has enjoyed as Congress’s primary vehicle for addressing the opioid abuse crisis.

Between April 2014 and July 2015, we hosted five bicameral forums highlighting different aspects of addiction and recovery—including the science of addiction, addiction and the criminal justice process, women and addiction, the collateral consequences of addiction, addiction and youth, and treatment and recovery in the veteran community.  Each of these forums brought together experts and practitioners from the prevention, treatment, law enforcement, and recovery communities to share best practices in their fields from across the United States.  Michael Botticelli, Director of the Office of National Drug Control Policy, joined us for several of these events.

In addition to hearing from stakeholders at these forums, the sponsors worked closely with a “working group” of organizations to craft legislation that would address the substance abuse crisis in a comprehensive manner.  The working group consisted of over 100 organizations—including the National Council on Behavioral Health, Community Anti-Drug Coalitions of America, Major County Sheriffs, Faces and Voices of Recovery, and many others.  The objective was to write a bill designed to incentivize evidence-based best practices and promote collaboration among all too often silo-ed areas of expertise. 

The nature of the grant programs, as well as the details and specificity attached to each grant program, in CARA as introduced in the Senate and House are a direct result of what the sponsors learned from the experts who participated in the forums and working group.  We must ensure that scarce federal resources are allocated to the programs that have been proven most effective, and preserving the distinct grant programs as set forth in the original bill would help ensure that. 

We must also ensure that our response to addiction includes targeted programs for each of the four CARA “pillars” of prevention and education, treatment, law enforcement efforts, and recovery.  With respect to recovery and prevention, we were concerned to see both key pieces left out entirely of the initial House package and urge you to make these important aspects of a meaningful substance abuse strategy a priority.  The evidence shows that peer-to-peer support programs and recovery high schools, authorized in Sections 303 and 304 of CARA, work, and that prison education, addressed in Section 401, significantly reduces both recidivism and incarceration costs.  In light of the overlap between addiction and the criminal justice system, giving inmates better tools to sustain their recovery makes common sense.  A single grant program with several broad allowable uses would fall short of guiding federal support toward evidence-based approaches in each of these critical areas.  Additionally, with fentanyl taking an increasing number of lives across the country, we believe that an evidence-based prevention and awareness campaign highlighting the dangers of fentanyl and the association between prescription opioids and heroin—like that under Section 102 of the Senate-passed CARA—will help better inform the public and save lives through prevention.  Further, Section 103 of the Senate-passed CARA, which authorizes grants for communities to address local drug crises, is an important component that represents enhanced federal support for local solutions to the substance abuse epidemic.

We urge you, in particular, to preserve Section 601 of the Senate-passed legislation.  This section creates incentive planning and implementation grants and requires applicants to have certain policies in place—including minimum requirements related to prescription drug monitoring programs (PDMPs).  As several organizations noted in their June 13 letter to conferees, “state PDMP databases help doctors spot early signs of addiction, such as requesting drugs from multiple doctors. They also prevent doctors from prescribing a drug that could be lethal in combination with another drug the patient is taking. . . Where PDMP use is voluntary, studies show they are rarely used. Without an effective PDMP, a doctor has no way of knowing what a patient might have been prescribed in another state.”[3] By awarding priority to states taking specific best practices to address addiction and recovery, Section 601 would help states plan and implement comprehensive strategies.

We have no objection to the package of Energy and Commerce bills added to CARA by the House, though in certain cases, we believe the Senate versions of those bills reflect better policy.  In particular, we would like to reference S. 1641 and S. 1455 in this respect.

Finally, while we drafted CARA as an authorization in light of our jurisdictional role as sponsors, we fully support new and robust funding to address what has been accurately termed an epidemic. More than 120 Americans a day, more than two Americans every hour, die from lethal overdoses.  We have come together as a country before to tackle health crises with funding far greater than what has been proposed in this context.  In 2009, Congress appropriated nearly $2 billion in emergency funding to fight the swine flu, which claimed the lives of more than 12,000 Americans.  Just last year, Congress approved $5.4 billion in funding to combat the Ebola outbreak in West Africa, an outbreak that killed one American.  We can, and should, come together again to tackle the opioid abuse crisis devastating our communities.

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